[Severe chronic ischemic ventricular dysfunction. Determinants of surgical risk and long-term clinical outcome].
BACKGROUND
In patients with chronic ischemic heart disease, a severe ventricular dysfunction is associated with a higher operative risk and to a worse late clinical outcome. However, when there is sufficient viable myocardium, surgical revascularization can improve ventricular performance and above all the functional capacity and survival of these patients.


OBJECTIVE
To analyze long-term results of a large series of patients with an ejection fraction < or = 0.30 that underwent isolated coronary artery bypass surgery and to investigate factors, mainly clinical, that determined favorable clinical results: being that the patient was alive and free of incapacitating symptoms.


METHODS
This series included 100 patients, 93 males and 7 females, with a mean age of 62 +/- 8 years. The predominant clinical manifestation was angina in 37, congestive heart failure in 22 and both in 41. Seventy-nine patients were in functional class III or IV, and 19 had emergency surgery.


RESULTS
There were 10 in-hospital deaths, 6 of which occurred in patients who had emergency surgery. Mortality in the elective cases was 4.9%. Only age (p < 0.05), functional class (p < 0.05) and emergency surgery (p < 0.0001) were identified as independent predictors of early mortality. Actuarial survival rates after 5 and 8 years were 65 and 52% respectively. Long-term clinical outcome was considered favorable in 66 patients. We did not find any preoperative clinical variables that were predictors of the clinical outcome. Only preoperative mitral insufficiency correlated with a poor long-term clinical result.


CONCLUSIONS
Patients with chronic and severe ventricular dysfunction secondary to coronary artery disease have an acceptable surgical risk when they are operated on electively, before their clinical condition deteriorates. Long-term results are satisfactory in the majority of the patients. In these types of patients clinical manifestations are of limited value in the selection process for surgical revascularization.
Guisasola
J S
JS
Servicio de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid.
González Santos
J M
JM
Ruiz Fernández
M
M
Castaño Ruiz
M
M
López Rodríguez
J
J
Bastida Centenera
E
E
Riesgo Benito
M
M
Salvador
J A
JA
Vallejo Ruiz
J L
JL
D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000150:complications* / Q000175:diagnosis
Disfunción ventricular isquémica crónica severa. Determinantes del riesgo quirúrgico y del resultado clínico a largo plazo.